Management of patients with SARS-CoV-2 infections with focus on patients with chronic lung diseases (as of 10 January 2022) : Updated statement of the Austrian Society of Pneumology (ASP).

The Austrian Society of Pneumology (ASP) launched a first statement on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in May 2020, at a time when in Austria 285 people had died from this disease and vaccinations were not available. Lockdown and social distancing were the only available measures to prevent more infections and the breakdown of the health system. Meanwhile, in Austria over 13,000 patients have died in association with a SARS-CoV­2 infection and coronavirus disease 2019 (COVID-19) was among the most common causes of death; however, SARS-CoV­2 has been mutating all the time and currently, most patients have been affected by the delta variant where the vaccination is very effective but the omicron variant is rapidly rising and becoming predominant. Particularly in children and young adults, where the vaccination rate is low, the omicron variant is expected to spread very fast. This poses a particular threat to unvaccinated people who are at elevated risk of severe COVID-19 disease but also to people with an active vaccination. There are few publications that comprehensively addressed the special issues with SARS-CoV­2 infection in patients with chronic lung diseases. These were the reasons for this updated statement. Pulmonologists care for many patients with an elevated risk of death in case of COVID-19 but also for patients that might be at an elevated risk of vaccination reactions or vaccination failure. In addition, lung function tests, bronchoscopy, respiratory physiotherapy and training therapy may put both patients and health professionals at an increased risk of infection. The working circles of the ASP have provided statements concerning these risks and how to avoid risks for the patients.

[Masterplan 2025 of the Austrian Society of Pneumology (ASP)-the expected burden and management of respiratory diseases in Austria]. / Masterplan 2025 der Österreichischen Gesellschaft für Pneumologie (ÖGP) ­ die erwartete Entwicklung und Versorgung respiratorischer Erkrankungen in Österreich.

Scientific Members of the Austrian Society of Pneumology describe the expected development in respiratory health and provide guidance towards patient-oriented and cost-efficient respiratory care in Austria.Methods: In November 2017, respiratory care providers (physicians, nurses, physiotherapists) together with patient's advocacy groups and experts in health development, collaborated in workshops on: respiratory health and the environment, bronchial asthma and allergy, COPD, pediatric respiratory disease, respiratory infections, sleep disorders, interventional pneumology, thoracic oncology and orphan diseases.Results: Respiratory disease is extremely prevalent and driven by ill-health behavior, i.e. cigarette smoking, over-eating and physical inactivity. For the majority of respiratory diseases increased prevalence, but decreased hospitalizations are expected.The following measures should be implemented to deal with future challenges:1. Screening and case-finding should be implemented for lung cancer and COPD.2. E-health solutions (telemedicine, personal apps) should be used to facilitate patient management.3. Regional differences in respiratory care should be reduced through E­health and harmonization of health insurance benefits across Austria.4. Patient education and awareness, to reduce respiratory health illiteracy should be increased, which is essential for sleep disorders but relevant also for other respiratory diseases.5. Respiratory care should be inter-professional, provided via disease-specific boards beyond lung cancer (for ILDs, sleep, allergy)6. Programs for outpatient's pulmonary rehabilitation can have a major impact on respiratory health.7. Increased understanding of molecular pathways will drive personalized medicine, targeted therapy (for asthma, lung cancer) and subsequently health care costs.

Management of patients with SARS-CoV-2 infections and of patients with chronic lung diseases during the COVID-19 pandemic (as of 9 May 2020) : Statement of the Austrian Society of Pneumology (ASP).

The coronavirus disease 2019 (COVID-19) pandemic is currently a challenge worldwide. In Austria, a crisis within the healthcare system has so far been prevented. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV­2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic; however, COVID-19 specific adjustments are useful. The treatment of patients with chronic lung diseases has to be adapted during the pandemic but must still be guaranteed.

Malignant disease as an incidental finding at ¹8F-FDG-PET/CT scanning in patients with granulomatous lung disease.

PURPOSE: Fluorine-18 fluorodeoxyglucose (¹8F-FDG)-PET/computed tomography (CT) is used for assessment of the extent and activity of disease in patients with inflammatory granulomatous lung disease, in particular sarcoidosis and tuberculosis. The aim of this retrospective analysis was to assess the value of ¹8F-FDG-PET/CT in the identification of previously unknown malignant disease during routine investigation of granulomatous lung disease. MATERIALS AND METHODS: From July 2008 to December 2013, a total of 122 patients with tuberculosis (76 male and 46 female patients; age range 19.6-88.6 years, mean 52.8±16.6 years) and 85 patients with sarcoidosis (46 male and 39 female patients; age range 17.8-76.5 years, mean 48.6±13.8 years) underwent ¹8F-FDG-PET/CT. Reports were generated in consensus by both a nuclear medicine physician and a radiologist. Possibly malignant findings underwent biopsies and/or follow-up. Quantitative parameters (maximum standardized uptake value) were pooled and compared from reference lesions in each group. RESULTS: Malignant disease was suspected in 18 of 122 tuberculosis patients and in eight of 85 sarcoidosis patients. Malignancy was finally confirmed in six patients with tuberculosis and in two patients with sarcoidosis. In one single case a malignant lung tumour had been overlooked on PET/CT. Patients were also analysed according to their age. In the patient group older than 60 years, four malignancies were confirmed in 44 tuberculosis patients and in one in 20 sarcoidosis patients, whereas in patients aged between 30 and 60 years only three of 63 tuberculosis and one of 58 sarcoidosis cases showed malignancy compared with the 18 false-positive findings on a total patient basis. The most common site of malignant disease was the chest. Besides the intrathoracic findings, two cases of malignancy were detected outside the thorax. Quantitative evaluation did not reveal any statistically significant difference between the tuberculosis and sarcoidosis groups. CONCLUSION: Differentiation between granulomatous inflammation and malignancy is challenging with ¹8F-FDG-PET/CT because of a large number of false-positive findings. The highest probability of detecting coexistent malignant disease was seen in patients older than 60 years who were suffering from tuberculosis. An important feature for identification of malignant disease, especially in the assessment of intrathoracic findings, has turned out to be the CT pattern; quantitative evaluation, in contrast, seems to have little clinical value.

Long-term glomerular filtration rate following pediatric liver transplantation.

In adult patients a significant proportion of chronic renal failure after liver transplantation (LTX) has been described. This was attributed mainly to nephrotoxicity caused by Calcineurin inhibitors (CNI). If these results are transferable to pediatric patients was the aim of this study. Forty-five pediatric patients with a LTX performed between 1988 and 2003 were evaluated. Glomerular filtration rate was calculated using the Schwartz formula (calculated GFR (cGFR) (mL/min/1.73 m2) = kx height (cm)/serum creatinine (mg/dL)). Median age at LTX was 4 yr (range 0.3-18.1). Pretransplant median cGFR was significantly elevated with 157.5 mL/min/1.73 m2. Within the first 3 months after LTX median cGFR normalized to a median value of 102.7 (p < 0.05 vs. pretransplant cGFR). During long-term follow-up median cGFR remained stable with calculated values of 108.0 two years and 112.6 five years after transplantation. Using a linear and an exponential one compartment mathematical modeling of renal function the calculated GFR was stable even for very long observation times (n > 10 yr). Liver insufficiency prior to transplantation was associated with glomerular hyperfiltration. After successful liver transplantation cGFR normalized within the first 3 month and, in contrast to the reported GFR impairment in adult liver transplant recipients, remained stable, even in long-term follow-up.

Nocardiosis following solid organ transplantation: a single-centre experience.

Nocardiosis is a localized or disseminated bacterial infection caused by aerobic Actinomyces that commonly affects immunocompromised hosts. The aim of this study was to retrospectively review clinical course and outcome of nocardiosis in solid organ recipients at our centre. Five cases of nocardiosis were identified in a series of more than 4000 consecutive solid organ transplants performed at Innsbruck university hospital during a 25-year period. Of the five patients with nocardiosis, two had undergone multivisceral, one liver, one kidney and one lung transplantation. Three patients with Nocardia asteroides infection were treated successfully and recovered from their infectious disease, however, one lost his renal graft following withdrawal of immunosuppression. The lung recipient recovered from nocardiosis but died later on from Pseudomonas pneumonia. One multivisceral recipient died from Nocardia farcinica-disseminated infection. Nocardiosis is a rare, difficult-to-diagnose-and-treat complication following solid organ transplantation. Intestinal recipients might be at increased risk to develop this infection.